Inflamed joint Flashcards
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what are the risk factors for gout
beer, renal impairment, diuretics. asprinin
what is the crystal in gout
monosodium urate
how would you test for Inflammatory arthitis
make some patient cases based onwhere arthtiis is present , symmetry to diagnose different arthities
mrs G, pain in hands, wordening over 1-1.5 yrs, decreased grip, Stiff am – 15 mins
Worst end of fingers, thumbs
Paracetamol and occasional brufen helps a bit
CRP 1.3 (normal range 1-5)
RF 24 (normal range 0-20)
Xray – degenerative changes in DIP joints of both hands and first CMC joints. No erosions
Brian -45
Presents with acute onset swelling of his right 1st MTP
Woke him from sleep
No trauma
No other joints involved
Pain so bad he can’t put his sock on
- gout
- Uric acid normal due to movement from blood to foot
what is the crystal in pseudo gout
calcium pyrophosphate dihydrate
describe pathogenesis of gour
- Hyperurecemia due to underexcretion of urate or overproductiom of urate
- crystal forming and shedding
- synovial cells
- inflammatory response
why sugery drinks are related to gout
fructose shares the same renal uric acid transporter
what are the typical joints that are effected in gout
1st MTPJ 90%
Midfoot, ankle, knee, wrist, elbow hand
what are the differentials for gout
septic arthiritis
calcium phosphate arthritis
rheumatoid arthritis
osteoarthritis in MTPJ (long time toe pain not acute)
what are the investigations for gout
FBC - raised wbc
UE
LFT - alcohol
Serum uris acid - during acite attack
CRP - expect high
what are the 4 clinical phases for untreated grout
- asmptomatic hyperurecemia
- acute and reacurring gout
- intercritical gout,
- chronic tophaceous gout
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how is gout treated
NSAID
colchicine - 500microgram 2-3x day
corticosteroids -
Analgesia dont work as don’t treat inflammation.
what are some chronic signs of gout
Tophi ( urec acid build up around joints)
